UPNS 232 Exam 2 Review

Chapter 28: Oxygen Therapy or Trach Care

 Respiratory distress signs
o Dyspnea (shortness of breathing)
o Nasal flaring
o Use of accessory muscles to breathe
o Pursed lip breathing (mostly COPD patients)
o Decreased endurance
o Skin and mucous membrane color changes (pallor, cyanosis)
o Tripod position: allows for diaphragmatic breathing
 O2 therapy purpose: relieve hypoxemia/hypoxia
o Hypoxia: low level of oxygen in the tissues
o Hypoxemia: low level of oxygen in the blood
 Complications of oxygen therapy
o Combustion
o Oxygen-induced hypoventilation
 Hypercarbia: retention of CO2 (acidic)
o Infection
o Oxygen toxicity
 PA02: 80-100
 If patient says PA02 is 160, oxygen level is too high
 If patient is on 8L, DECREASE
o Normal function: patient breaths when CO2 levels rise****
 When SPO2 drops and waveform is perfect, person NEEDS OXYGEN***
 When SPO2 drops and waveform is NOT perfect, this is just a falty pulse ox
 If COPD patient relies on high CO2 level to breath, when you lower this they might not
be able to breath (not used to low levels)
o What causes them to breath: lack of oxygen
o Body switches from hypercapnia drive to hypoxic drive
o Give them too much O2, their drive to breath is reduced
 Oxygen delivery systems depend on
o O2 concentration required/achieved
o Importance of accuracy and control of oxygen concentration
o Patient comfort
o Importance of humidity
o Patient mobility
 If patient is able to walk, that is important to get them to be mobile***
 Low flow O2 systems
o Nasal cannula (1-6 L)
 Important to look at patency of nostrils; want to make sure nose is not
bleeding (epistaxis)
 Assess for changes in respiratory rate and depth

,  Oximyzer: looks like nasal cannula but much thicker; higher flow
o Facemask
 Simple: increase oxygen
 Minimum of 5 L
 Delivers O2 up to 40-60%
 Monitor closely for risk of aspiration especially is they have
decreased LOC
 Partial rebreather: 6-10 L
 FI02: 60-70%
 Allow patient to rebreathe some of their exhaled CO2
 Non-rebreather: 10-15 L; does not allow patient to rebreath exhaled CO2
 One way valves are what differentiate non-rebreather from
rebreather
 FI02
 Used for unstable patients who require intubation
 High-flow O2 systems: Deliver up to 24-100% O2; 8-15 L
o Venturi mask
 Titrate different oxygen levels
 BEST FOR CHRONIC LUNG DISEASE PATIENTS
 Hypercapnic-hypoxic drive
 COPD patients will switch to hypoxic drive
 If given high amounts of O2, body will not recognize they are
hypoxic and have respiratory arrest
 Switch to nasal cannula during meal times
o Face tent
o Aerosol mask
o Trach collar
 If you have trach, simple face mask for trach
o T-piece
 Connective device to trach
 Provides oxygenation and humidification
 Mist should be seen during inspiration and expiration
o FOR PATIENTS NEEDING HIGH FLOW O2
 Take break from eating if their pulse ox drops
 Take small meals
 Tracheostomy
o Tracheotomy: surgical incision made into trachea to establish an airway
o Tracheostomy: stoma that results from tracheotomy
o Immediately after surgery, patient may have a trach
 If patient is doing fine, decanulate patient and remove trach
 Dead-ender cap put on stoma to discontinue it
 Complications of trach
o Pneumothorax

, o SUBQ emphysema (crackles in skin, sounds like rice krispy’s)
o Bleeding
o Infection
 Trach tubes
o Always have suction device for patient to clear secretions
o Obturator: guide to help put the inner cannula in; does NOT have a hole to
breathe through****
 Not used unless emergency or changing size
o Make sure cuff is not overly inflated
o Inner cannula is disposable
 Possible issues with a patient with a trach
o Cuff pressure can cause mucosal ischemia or erosion
 Check pressure often, make sure you have trach ties
o Prevent hypoxia
o Prevent tube friction and movement
 Causes of hypoxia in trach
o Ineffective oxygenation before, during, and after suctioning
o Use of catheter is too large for artificial airway
o Prolonged suctioning time
o Excessive suction pressure
o Too frequent suctioning
 Trach care
o Assess patient
o Secure trach tubes in place
o Always make sure you have someone else when changing trach ties so cannula
does not fall out and you can secure placement
o Prior to this: hyperoxygenate*****
 Air must be humidified and have proper temp as well for trach
 Ensure adequate nutrition
 Maintain proper temp
 Suctioning
o Maintains patent airway
o Cannot cough adequately; suctioning is needed
o If patient does not have trach, CAN nasotracheal suction
 Complications with suctioning
o Hypoxia
o Tissue trauma
o Infection
o Vagal stimulation, bronchospasm
o Cardiac dysrhythmias from prolonged hypoxia
 Bronchial and oral hygiene
o Make sure you turn every 2 hours
o Percuss on back and loosen secretions (ordered by doc typically)